生酮饮食治疗儿童难治性癫痫的临床疗效Meta分析  

Clinical efficacy and benefit-risk network Meta-analysis of ketogenic diet in the treatment of refractory epilepsy in children

作　　者：王伟军 杨旭红[1] 韩琪荣 高雯 WANG Weijun;YANG Xuhong;HAN Qirong;GAO Wen(Department of Neurology,Hospital of Chengdu University of Traditional Chinese Medicine,Chengdu 610075,China)

机构地区：[1]成都中医药大学附属医院神经内科,成都610075

出　　处：《癫痫杂志》2021年第3期214-227,共14页Journal of Epilepsy

摘　　要：目的分析比较各种生酮饮食(Ketogenic diet,KD)治疗儿童难治性癫痫的疗效及不良反应之间的差异。方法系统地搜索了电子数据库,包括PubMed,Embase,Ovid MEDLINE,Web of Science和Cochrane对照试验中央登记册,以英文发表2000年01月—2020年8月的相关研究。最终纳入文献11篇,纳入病例781例。采用Meta分析(NMA)方法比较6种生酮饮食[经典KD(Classic ketogenic diet,CKD)、逐步启动KD(Gradual ketogenic diet initiation,GRAD-KD)、最初20 g碳水化合物/d的改良阿特金斯饮食(Initial 20 g of carbohydrate/day of modified Atkins diet,IMAD)、改良阿特金斯饮食(Modified Atkins diet,MAD)、低血糖生成指数饮食(Low glycemic index diet,LGID)和中链脂肪酸饮食(Medium-chain triglyceride diet,MCT)]疗法3、6、12个月的疗效及不良反应。结果直接比较分析结果显示:CKD、MAD的3个月癫痫发作减少50%的临床疗效优于CAU,差异具有统计学意义[OR=10.58,95%CI(3.47,32.40),P<0.05;OR=11.31,95%CI(5.04,25.38),P<0.05];MAD的3个月癫痫发作减少90%的临床疗效优于CAU,差异具有统计学意义[OR=4.95,95%CI(1.90,12.88),P<0.05]。进一步NMA结果提示:3个月癫痫发作减少50%的临床疗效比较:IMAD、GRAD-KD、CKD、MAD、MCT优于CAU,差异具有统计学意义[OR=0.03;95%CI(0.00,0.30),P<0.05;OR=0.07;95%CI(0.01,0.76),P<0.05;OR=0.11;95%CI(0.03,0.35),P<0.05;OR=0.11;95%CI(0.04,0.35),P<0.05;OR=0.13;95%CI(0.03,0.67),P<0.05;OR=0.11;95%CI(0.03,0.35),P<0.05;OR=0.11;95%CI(0.04,0.35),P<0.05]。3个月癫痫发作减少90%的临床疗效比较:CKD、GRAD-KD、IMAD、MAD、MCT优于CAU,差异具有统计学意义[OR=0.05;95%CI(0.00,0.31),P<0.05;OR=0.22;95%CI(0.00,0.39),P<0.05;OR=0.03;95%CI(0.00,0.62),P<0.05;OR=0.12;95%CI(0.01,0.60),P<0.05;OR=0.09;95%CI(0.00,0.91),P<0.05]。累计概率图提示:3个月癫痫发作减少50%的临床疗效最佳临床方案为IMAD(Rank1=0.91),6个月癫痫发作减少50%的临床疗效最佳临床方案为CKD(Rank1=0.40),12个月癫痫发作减少50%的临床疗效�Objective Analyze and compare the differences in the efficacy and adverse reactions of various ketogenic diet(KD) in the treatment of refractory epilepsy in children. Methods Systematic search of electronic databases, including PubMed, Embase, Ovid MEDLINE, Web of Science and the Central Register of Cochrane Controlled Trials, published in English January 2000 Relevant research from January to August 2020. Results: Finally, 11 articles were included and 781 cases were included. Meta-analysis(NMA) method was used to compare 6 classic ketogenic diets(Classic ketogenic diet, CKD), Gradual ketogenic diet initiation(GRAD-KD), and the first modified Atkins diet of 20 g carbohydrates/d(Initial 20 g of carbohydrate/day of modified Atkins diet, IMAD), modified Atkins diet(MAD), low glycemic index diet(LGID) and medium-chain fatty acid diet(Medium-chain triglyceride diet, MCT) Therapeutic effect and adverse reactions of 3, 6, and 12 months. Results From the results of the direct comparative analysis, CKD and MAD showed superior clinical efficacy in 50% seizure reduction at 3 months to CAU, and the difference was statistically significant [OR=10.58, 95%CI(3.47, 32.40), P<0.05;OR=11.31, 95%CI(5.04, 25.38), P<0.05];the clinical efficacy of 90%seizure reduction at 3 months for MAD was superior to that of CAU with statistical significance [OR=4.95, 95%CI(1.90,12.88), P<0.05]. The results of further network meta-analysis suggested that for the comparison of 50% seizure reduction at 3 months, IMAD, GRAD-KD, CKD, MAD, and MCT were superior to CAU, and the difference was statistically significant [OR=0.03;95%CI(0.00, 0.30), P<0.05;OR=0.07;95%CI(0.01, 0.76), P<0.05;OR=0.11;95%CI(0.03, 0.35),P<0.05;OR=0.11;95%CI(0.04, 0.35), P<0.05;OR=0.13;95%CI(0.03, 0.67), P<0.05;OR=0.11;95%CI(0.03, 0.35), P<0.05;OR=0.11;95%CI(0.04, 0.35), P<0.05]. For the comparison of 90% seizure reduction at 3 months, CKD, GRAD-CK,IMAD, MAD, and MCT were superior to CAU, and the differences were statistically significant [OR=0.05;95%CI(0.00,0.31), P<0.05;OR=0.22

关 键 词：生酮饮食 难治性癫痫 儿童 META分析 

分 类 号：R742.1[医药卫生—神经病学与精神病学]